Kim Seo Yun, Kim Heejung, Chee Wonshik, Im Eun-Ok
Author Affiliations: Department of Nursing, Gangneung-Wonju National University (Dr S.Y. Kim), Gangwon-do; Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University (Dr H. Kim), Seoul, South Korea; and School of Nursing, The University of Texas at Austin (Drs Chee and Im).
Cancer Nurs. 2024 Apr 24. doi: 10.1097/NCC.0000000000001354.
Despite increased research on breast cancer survivors, little is known about how socio-behavioral factors influence the symptoms among racial/ethnic minority breast cancer survivors, particularly Asian American breast cancer survivors (AABCS).
This study examined the relationship between multiple socio-behavioral factors in AABCS, including attitudes, perceived barriers, and social influences, and their symptom experiences, with an emphasis on the mediating effect of self-efficacy.
This secondary analysis used data collected from 195 AABCS women recruited through online and offline communities from January 2017 to June 2020. Study variables were measured using validated instruments such as the Questions on Attitudes, Self-Efficacy, Perceived Barriers, and Social Influences; the Cancer Behavior Inventory; and the Memorial Symptom Assessment Scale-Short Form. For structural equation modeling based on Bandura's self-efficacy theory, mediation analysis was performed using SPSS version 26.0 and AMOS 28.
The overall fitness of the hypothetical model to the data is acceptable (χ2 = 51.36, P < .001; goodness-of-fit index = 0.95, adjusted goodness-of-fit index = 0.89, comparative fit index = 0.96, Tucker-Lewis index = 0.94, normed fit index = 0.94, and root-mean-square error of approximation index = 0.08). Both attitudes and social influences indirectly influenced symptom distress through self-efficacy (β = -0.054, P = .019, and β = -0.053, P = .017, respectively). Perceived barriers had indirect effects through self-efficacy (β = 0.121, P = .024) and significant direct effects (β = 0.605, P = .003) on symptom distress.
Our findings supported that the self-efficacy for coping mediated their symptom experience among AABCS. In addition, there were significant relationships among attitudes, perceived barriers, social influences, and symptom experience.
Future theory-driven interventions need to consider self-efficacy and socio-behavioral factors in symptom management among AABCS.
尽管对乳腺癌幸存者的研究有所增加，但对于社会行为因素如何影响种族/族裔少数群体乳腺癌幸存者，尤其是亚裔美国乳腺癌幸存者（AABCS）的症状，我们知之甚少。
本研究探讨了AABCS中多种社会行为因素（包括态度、感知障碍和社会影响）与她们的症状体验之间的关系，重点关注自我效能感的中介作用。
这项二次分析使用了2017年1月至2020年6月期间通过线上和线下社区招募的195名AABCS女性的数据。研究变量使用经过验证的工具进行测量，如态度、自我效能感、感知障碍和社会影响问卷；癌症行为量表；以及纪念症状评估量表简表。基于班杜拉的自我效能感理论进行结构方程建模，使用SPSS 26.0版和AMOS 28进行中介分析。
假设模型与数据的整体拟合度可以接受（χ2 = 51.36，P <.001；拟合优度指数 = 0.95，调整后拟合优度指数 = 0.89，比较拟合指数 = 0.96，塔克 - 刘易斯指数 = 0.94，规范拟合指数 = 0.94，近似误差均方根指数 = 0.08）。态度和社会影响都通过自我效能感间接影响症状困扰（β = -0.054，P =.019，以及β = -0.053，P =.017）。感知障碍通过自我效能感产生间接影响（β = 0.121，P =.024），并对症状困扰产生显著直接影响（β = 0.605，P =.003）。
我们的研究结果支持应对自我效能感在AABCS的症状体验中起中介作用。此外，态度、感知障碍、社会影响和症状体验之间存在显著关系。
未来基于理论的干预措施需要考虑AABCS症状管理中的自我效能感和社会行为因素。
